The Quantum Academies

NAME:

TELEPHONE:

EMAIL:

CITY, STATE/PROVINCE:

DO YOU HAVE SCHOLARSHIPS FOR THE INTERMEDIATE AND ADVANCED TRAININGS THROUGH THE QUANTUM ALLIANCE?

Yes
No

IF YOUR PARTNER IS THE REGISTERED OWNER OF A BIOFEEDBACK DEVICE THROUGH THE QUANTUM ALLIANCE, PLEASE PROVIDE YOUR PARTNER'S NAME:

I HAVE COMPLETED THE SIX DAY BEGINNERS TRAINING COURSE:

Yes
No

I SUCCESSFULLY PASSED THE ANATOMY AND PHYSIOLOGY EXAM:

Yes
No

I SUCCESSFULLY COMPLETED THE IQUIM BIOFEEDBACK HOME STUDY COURSE:

Yes
No

THE DEVICE THAT I WILL BRING TO THE TRAINING IS:

iNDIGO
SCIO
I Will Share an iNDIGO With My Partner
I Will Share a SCIO With My Partner
Other

I WISH TO REGISTER FOR THE FOLLOWING TRAINING:

INTERMEDIATE AND ADVANCED: Louisville, Colorado Sep. 20-25
INTERMEDIATE AND ADVANCED: Redondo Beach, California Sep. 20-25
INTERMEDIATE AND ADVANCED: Toronto, Ontario Sep. 20-25
INTERMEDIATE AND ADVANCED: Winnipeg, Manitoba Oct. 2-7
INTERMEDIATE AND ADVANCED: Portland, Oregon Nov. 8-13
INTERMEDIATE AND ADVANCED: Escondido, California Nov. 15-20
INTERMEDIATE AND ADVANCED: Toronto, Ontario Dec. 6-11

Cancellations with less than two weeks notice will be assessed a fee of $75. Failure to show up for the class to which you are registered without submitting a prior cancellation notice shall result in an assessment fee of $150.

I acknowledge and understand the Cancellation Policy.

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